'Nutrition for Growth': mainly good news

11 June 2013
Comment

When you work on international development there’s seldom a shortage of bad news. All the more reason to celebrate the good news when it comes along. And last weekend’s food-security summit delivered some good news for global efforts to combat malnutrition, which blights so many lives and destroys so much potential. The challenge now is to act on the commitments and consign a long-standing disgrace to history by 2030.

The food-security summit marked the culmination of a renewed push to make inroads on under-nutrition. That push has been well summarised by ONEs Molly Kinder. Governments around the world have finally taken on board that the Millennium Development target of halving the proportion of children underweight between 1990 and 2015 is unlikely to be met across swathes of Africa and South Asia. Given the long-run costs of under-nutrition, this will be a costly failure both socially and economically.

The ONE checklist for delivery, produced ahead of the summit, provides a useful benchmark for assessing performance. It lists five priorities: country plans; funds; ownership; transparency; and evidence.

So how did the summit perform in these areas?

  1. Country plans. Molly wished for countries to commit to producing ‘high quality, peer reviewed and accountable nutrition plans’, perhaps using a process similar to that of the Comprehensive Africa Agriculture Development Programme (CAADP). In large measure the importance of the country plans was agreed: they will be drafted or revised and published. But no mention was made of the sort of framework for processes that CAADP has created for agriculture in Africa.

  2. Funds. Nutrition has been a ‘Cinderella’ in development financing for at least two decades. The summit headline is that the pledges have been made, with donors announcing new commitments for 2013 to 2020 of up to US$4.15 billion for direct nutritional interventions, plus as much as US$19 billion more for improving the nutritional outcomes of nutrition-sensitive programmes (which mainly means agriculture, primary health care, water and sanitation).

    How does this measure up against the financing requirements for eradicating stunting by 2020? Lawrence Haddad has considered this in some detail. His best guess is that the US$4.15 billion will meet 40% of the required donor finance. Not bad, as he comments, but that still leaves US$6 billion for the donors to find, US$4 billion of pledges to materialise and be spent sensibly, donor fatigue not to set in and [the Scaling Up Nutrition initiative] SUN to help civil society in high-burden countries encourage/pressure their governments (especially India and Indonesia) to find the US$24.5 billion of domestic resources.

    There are other concerns. It isn’t clear as yet how much of the finance pledged at the summit will be additional to existing commitments. Nor is it clear how much national governments will commit: some heavy hitters such as India and Pakistan were absent from the summit. Then, of course, there is the question of capacity within countries to deliver resources effectively.

    The outcomes on mechanisms for delivery are more mixed. ONE hoped for an independent nutrition fund from which programmes would be funded on merit, or failing that a trust fund held at the World Bank with monies released when plans have been peer-reviewed. Payment for results, with funding for every child not stunted, or looking at alternative social financing mechanisms (for example, development impact bonds),might also have been considered. None of those ideas were in evidence. Funds, it seems, will be disbursed by conventional aid channels.

  3. Ownership by developing countries and regions. Plenty of evidence of this was on show, with 24 countries endorsing the Global Nutrition for Growth Compact, and 13 announcing targets for reducing stunting that exceed the World Health Assembly 2025 targets set in May 2012. Of course, statements of intent are a weak proxy for political commitment. Even so, this is a step in the right direction.

  4. Transparency of donors and developing countries of their commitments, disbursements and outcomes. The summit made considerable commitments to this, with those signing the Compact promising to make ‘data readily available to citizens and stakeholders, and to track progress publicly against all commitments made. This will include the publication of an annual global report on nutritionand publication of country plans and reports of spending on nutrition, and on monitored progress in reducing stunting, increasing breastfeeding and treating severe acute malnutrition.’ There will be an annual meeting to take stock, to be held at the UN General Assembly. Promises were also made to back ‘clear and ambitious nutrition targets, with relevant indicators, within the Post-2015 Development Agenda.’

  5. Evidence. Investments will be subject ‘to rigorous monitoring and accountability measures’ with mention of ‘new ways to promote learning between countries with different levels of experience and success in tackling undernutrition. The Global Panel on Agriculture and Food Systems for Nutrition, launched today, will review emerging research on agriculture and food systems, and provide leadership to accelerate progress in tacking under-nutrition.

So far, so good. But did the summit miss any tricks? Perhaps one: public services. The summit made much ofthe contributions of science and business. Thats all well and good: of course they have contributions to make. Better techniques are always welcome, as is business that serves the common good and not just shareholder dividends.

Yet most of what needs to be done to improve nutrition is already well known; most of it involves delivering public goods. Yes, there are some private goods in the mix, most notably food. But so much of the rest – roads and power that support farming, primary health care, public education campaigns, female schooling, water and sanitation need either public provision or considerable public steering. That is why the bill for nutrition-sensitive investments is large. It would have been nice to have given a few cheers to public services – and above all the front-line staff, often ill paid, who deliver services and programmes working with few resources in difficult circumstances. Given support, they can achieve much. In those places in the developing world where stunting rates are below expectations given wealth, look for good public services – and low income inequality.

Much of what matters once the plans are drafted and the funds are granted lies with front-line workers and their clients. So we might consider how to provide incentives to the community workers, and volunteers, and to the young mothers of the developing world who will be crucial to eradicating under-nutrition. Can the new media (mobile technology and internet) be used to convey messages in one direction while harvesting data and stories in the other? Can this be used to rouse the press and TV from their slumber on malnutrition?

This aside, three cheers for the summit. It’s one more valuable step forward. Now comes the challenge of making the additional funds work to good effect.